Kevin, M.D. - Medical Weblog

Wow, what a brilliant insight and such a professional demeanor. The result will be for community outpatient specialists to decline all referrals from the ER setting.

As it stands already, the mandatory risk management courses we are take all recommend avoiding ER cases like the plague.

This attitude should make the ER doctors' job infinitely harder.

Ed Sodaro MD
 

Let me tell you about "a$$wipes" I've dealt with over my weekend on call.

Called in to deal with foreign body deep in the pharynx. GI declined the consult saying they wouldn't be able to visualize it if it were above the pharyngo-eosphageal junction. In I drive 16 miles only to discover that a shard of poultry bone is superficially embedded in one of the tonsils- a finding which would have been evident to the ED doc if he'd BOTHERED TO EXAMINE THE PATIENT (instead of getting a CT scan). It could have been removed by anyone with a flashlight a pair of tweezers. Ooops.

I get called to come to take care of a nosebleed that just won't quit. What has the ED doc done? Made one pass at sticking a stupid little sponge into the nostril. SURPRISE! Those damned things don't work. I inform the ED doc that I'll come in only after he's made a good faith effort to place a REAL pack in the patient's nose. I hear nothing further from him that night. Funny what happens when you actually do the right procedure.

This situation repeats itself the next day. Likewise I compel the doctor to do the right thing and I hear nothing further.

I get called in near midnight to pack a nose on a patient that had a pair of sponges stuck in his nose by another ER before being turfed to our hospital. SURPRISE! Those damned things don't work- or they DO work, at least long enough to get the patient out of the ED.

When I stop getting stupid calls from the ED and don't have to re-do their shoddy work, I'll develop a better attitude.
 

It would seem to me that approach would land the ER doc in serious hot water and further poison the relationship with the consultants.
 

Using patients as weapons to take revenge is always completely and totally unethical.
 

I don't ever get called by the ED doc. Nope, the midlevel is usually the one who has seen the patient at our Level I trauma center. Funny thing is, I usually find the workup is more complete than that performed when the the ED doc used to do it!
 

"but my shift is up" is our ER's way of saying "no workup has been done, but you're a real doctor so you figure it out"

I understand a renin level won't come back in a few hours, but a 75 year old woman on coumadin with altered mental status ought to get a head CT and maybe a lab or 2 before the ER says "well she can't go home."

No, apparantly but she can die on my ward from the hemmorrage you missed...

Maybe if the ER did their job consistenly then medicine, surgery and everyone else would be more willing to do theirs.
 

Refreshing to see everyone calling bull$hit on this ED doctor's rant. This follows closely on the heels of yet another absurd plea for consultants to "Step up to the plate!" by a seriously naive Dr. Leap.
 

What the ER doc forgets is everybody in medicine deals with a$$holes (including ER docs themselves). This is not an ER limited thing issue. His answer may have had the ER hens on his blog clucking in agreement but it is not a solution and if he really does this he very well may find himself in hot water with his hospital. He may get away with it with some lowly FP or IM that the hospital doesn't really care about. However, if some big gun orthopod, cards, or neurosurgeon with a chip on his/her shoulder complains he will hear about and very well may end up looking for a new job. The fact is though ER docs are in relative short supply, it is a heck of a lot easier to replace one of them than a surgical specialist. In a one or the other situation which an "a$$wipe consultant" (his words) might force, the hospital in this instance will look at it's botton line. Who do you think they will choose? The money maker for the hospital (ie. not the ER doc). A more appropriate "professional" thing to do would be to file a complaint with appropriate hospital doctor "professionalism" committee. Isolated complaints may do nothing, however repeat offenders eventually often are addressed. I saw one guy who was forced into anger management by the hospital or was facing loss of hospital priv. The answer to dealing with unprofessional behavior is not to act passive-aggressive and unprofessional way yourself but to address it head on. Is this concept so hard to grasp in the ER? This ER docs idea of a solution has been used in various permutations for decades. Has it changed anything. In the long run, by decreasing consultants he only hurts his patients and himself.
 

"Lowly FP or IM"?

This statement is demonstrative of the problem. Are you always so professional when you denigrate your colleagues?
 

Read for comprehension. I am talking about the hospital's opinion not my own. I am an IM doc. I can tell you first hand while sucking up to surgical subspcialists on one hand they couldn't give a damn about IM docs. Example, do you ever think they will pay an IM doc for taking call like surgeons are often payed now.
 

911 doc now deletes all comments on this thread as it has been shown how much of a twit he really is.
 

Go check out this guy's website and see how he handles criticism. Pure invective and profanity. youwonder if the lady doth protest too much.
 

I consulted a neurosurgeon today in the ER...I was asked by the neurosurgeon if i did a give-take neuro exam. Anyone know what a give-take neuro exam is? If it helps, we were wondering if a neuro complaint could have potentially been psych in origin.

Thanks,
med student